Denosumab Associated With Significant Increases in BMD in Glucocorticoid-Induced Osteoporosis

Denosumab is associated with significant improvements in bone mineral density (BMD) in patients with glucocorticoid-induced osteoporosis at 12 months of treatment, according to the results of a systematic review and meta-analysis published in Rheumatology Advances in Practice.

The monoclonal antibody denosumab is used to treat glucocorticoid-induced osteoporosis, but it is unclear whether its use is associated with meaningful increases in BMD. Researchers performed a systematic review and meta-analysis of original studies with patients with glucocorticoid-induced osteoporosis treated with denosumab to evaluate the effects on BMD gains at the lumbar spine, total hip, and femoral neck.

Investigators performed a literature search of the PubMed, Web of Science, and Google Scholar online databases for studies performed between 1960 and March 31, 2019; inclusion criteria were data from original studies that included human participants, which provided raw data on the rate of change of BMD after denosumab administration. Mean differences in rate of change were compared between patients who received denosumab vs bisphosphonates.

From the 713 studies identified, 7 met the inclusion criteria for meta-analysis. The pooled patient population included 437 individuals, predominantly women, with mean ages ranging from 48.4 to 66.7 years. Denosumab was most frequently prescribed at a 60-mg dose.

Compared with baseline, at 6 months, denosumab treatment was associated with significant increases in BMD of the lumbar spine (2.99%; 95% CI, 2.71%-3.28%; P <.0001) and total hip (1.34%; 95% CI, 0.64%-2.04%; P =.0002). Significant gains in BMD were also observed at 12 months at the lumbar spine (4.59%; 95% CI, 4.17%-5.01%; P <.0001) and total hip (2.16%; 95% CI, 2.05%-2.27%; P <.0001), as well as BMD of the femoral neck (1.55%; 95% CI, 0.45%-2.65%; P =.0059).

The effects of denosumab and bisphosphonate treatment on the lumbar spine and femoral neck BMD were evaluated at 6 and 12 months. No significant difference was observed at 6 months, but gains in femoral neck BMD were higher in the denosumab- vs bisphosphonate-treated group at 12 months (0.97%; 95% CI, 0.33%-1.60%; P =.003). No significant difference was observed in fracture risk.

Researchers noted that some of the included studies did not provide information on the dose or duration of corticosteroid treatment, which may have affected the efficacy of denosumab.

“Patients with [glucocorticoid-induced osteoporosis] experienced significant increases in BMD in response to treatment with denosumab that were detected in the lumbar spine, total hip and femoral neck at 12 months,” the researchers concluded. “Although there are still problems with denosumab treatment, such as long-term efficacy and complications (risk [for] atypical fracture and jaw necrosis), we conclude that denosumab is an effective treatment for [glucocorticoid-induced osteoporosis].”

Reference

Yamaguchi Y, Morita T, Kumanogoh A. The therapeutic efficacy of denosumab for the loss of bone mineral density in glucocorticoid-induced osteoporosis: a meta-analysis [published online March 13, 2020]. Rheumatol Adv Pract. doi:10.1093/rap/rkaa008